Madigan Army officials ease up on reviews of combat-stress cases

Officials at Madigan Army Medical Center in Tacoma, Wash., said they had… (Madigan Army Medical Center )

JOINT BASE LEWIS-McCHORD, Wash. — Officials at the largest Army medical center in the West said Thursday that they have eliminated second-tier psychiatric reviews for soldiers diagnosed with combat stress. The change, they said, is part of a new effort to eliminate disparities in diagnoses and remove the stigma for service members looking for psychological help.

“Our No. 1 concern is taking care of these soldiers…. We’re moving forward, doing the right thing,” said Lt. Gen. Robert B. Brown, commanding general of the Army’s I Corps, at a news conference detailing the policies unveiled earlier this week.

The announcement reverses a highly controversial program that subjected soldiers diagnosed with post-traumatic stress disorder at Madigan Army Medical Center to a second, often-cursory review by a forensic psychiatrist using common diagnostic benchmarks. Those reviews frequently resulted in a reversal of the diagnosis.

As a result, nearly 300 soldiers suffering from severe stress who otherwise would have been entitled to full medical benefits through a medical retirement from the Army were forced to seek medical help on their own if they left active-duty service, according to Sen. Patty Murray (D-Wash.), chairwoman of the Senate Veterans Affairs committee, who initially sought an investigation into the program.

The change follows an inquiry launched after widespread allegations that the Army was implementing the forensic reviews in an attempt to save money. A briefing document presented recently at Madigan even advised medical practitioners to be aware that a PTSD diagnosis can result in lifetime payouts of up to $1.5 million per soldier.

Senior Army administrators at Madigan said Monday that cost issues played no role in the decision either to implement the forensic psychiatric reviews or to eliminate them. One of the chief concerns, they said, was that soldiers elsewhere in the country were not required to undergo forensic examinations, leading to a disparity in treatment for soldiers at Madigan, located at Joint Base Lewis-McChord near Tacoma.

“We’re about taking care of soldiers, and I have never known a commander who worried about cost in taking care of their soldiers and their families,” Brown said.

Further, administrators said, the costs of dealing with untreated combat stress, whose most severe form is PTSD, are substantial as well.

“We can’t afford not to spend those dollars right now to help those folks,” said Maj. Gen. Richard Thomas, commander of the Western Region Medical Command, which oversees Army healthcare across 20 Western states. “The cost of not taking care of those soldiers is going to be astronomical. The damaged lives … the substance abuse and everything that goes with it. They deserve the best we can give them. So I think it’s money well spent.”

The Army so far has refused to release the results of the investigation or to discuss in detail its specific findings.

Officials did say that the commander of Madigan medical center, who had been suspended when the investigation was launched, has been reinstated. He was found not to have exerted any undue influence over PTSD diagnoses, instead enforcing what were standard medical guidelines at the time, they said.

“There was nothing done wrong. He’s the right leader,” Brown said. He said the Army is “a learning institution” and that once shortcomings were identified, “let’s move on.”

Army officials said the investigation identified about 1,700 soldiers who had been processed by the forensic psychiatry team at Madigan. Of those, about 450 — presumably those whose initial PTSD diagnosis was brought into question as a result of the forensic reviews — were brought in for a thorough reevaluation.

The Army subsequently expanded its review of PTSD evaluations to military medical centers across the country. Only at Madigan was the practice of using second-tier forensic psychiatry reviews in place, they said, in part because Madigan is one of the best-staffed military hospitals in the country.

“What we found is that the forensic methods are not the right ones for the United States Army disability system," Gen. Lloyd Austin, Army vice chief of staff, said in a statement. “We learned [Madigan] officials acted in accordance with the standard of practice for civilian disability evaluations. But we also learned that while the evaluation may be fair and appropriate, it’s simply not optimal for the unique cases that the Army diagnoses and reviews. We’ve fixed that.”

Some of the reevaluations revealed that soldiers indeed did not have PTSD. Others resulted in having PTSD diagnoses reinstated, allowing soldiers to go forward with medical retirements and ongoing counseling and treatment.

Spec. Jared Enger, who was twice deployed to Iraq, is one of those whose PTSD diagnosis was reinstated. He said his initial diagnosis, given by mental health counselors who had worked with him closely for a long period of time, was rejected without much explanation after a brief meeting with a forensic psychiatrist.

“I had been diagnosed by multiple doctors at Madigan, I went through inpatient treatment. And then the forensic psychiatrist I saw for all of five minutes, I guess, made a determination that he thought I didn’t have any issues,” Enger said in an interview.

“It’s really been exhausting mentally to have to fight something like that, because it’s not something you’re very proud of, not something you want to wave your flag out and say, ‘Hey, I have this issue,’ ” he said.

Army administrators said one of the chief aims of the new policies is to make it easier for service members to seek help with combat stress and reduce the stigma still sometimes attached to asking for psychological help.

“I see more and more soldiers coming forward,” Brown said. “But until the stigma’s gone, it’s not enough.”